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Biologic Use for Psoriatic Arthritis Inconsistent in Poorer Countries

The use of biological DMARDs was similar across countries, but in less wealthy countries, more patients with moderate/high disease activity were not receiving biologics.

Patients with psoriatic arthritis (PsA) from the poorest countries are more likely to have high disease activity and worse disease impact, while patients with high or moderate disease activity from these countries are less likely to be treated with biological disease-modifying antirheumatic drugs (bDMARDs). This is according to study results published in RMD Open.1

“National and international organizations need to promote equity for all patients with PsA,” Florian Lucasson, of Sorbonne University in Paris, France, and colleagues, stated.

In this cross-sectional analysis, researchers explored the role of a country’s wealth on outcomes in PsA. Consecutive patient data from the Remission/Flare in PsA study were included from 13 countries that were classified into tertiles by gross domestic product (GDP) per capita. The lowest tertile included Brazil, Turkey, Russian Federation, Romania, and Estonia; the middle tertile included Spain, Italy, the UK, and France; and the highest tertile included Canada, Germany, the US, and Singapore. Disease Activity in PsA (DAPSA), Minimal Disease Activity (MDA), patient-reported outcomes and bDMARD use were analyzed per country and compared between the tertiles.

In 439 patients (50.6% male, mean age 52.3 years, mean disease duration 10.1 years), disease activity was highest in the lowest GDP per capita countries. DAPSA remission was achieved by only 7.0% of patients in the lowest tertile compared with 29.1% and 16.8% in the middle and high tertiles, respectively (p<0.001). Similar results were seen with MDA, achieved in 18.4%, 49.5%, and 41.3% of patients, respectively (p<0.001).

The use of bDMARDs was similar in the tertiles, with an overall mean of 61%. Investigators noted that while bDMARD use was slightly lower in the lowest tertile, this was a non-significant finding. For conventional synthetic DMARDs, methotrexate use was 63.3% in the lowest tertile, compared with 46.5% in the middle tertile and 52% in the highest tertile (p=0.035). The overall rate of patients with DAPSA >14 and no bDMARDs was 18.5%, which was higher in lower GDP per capita countries at 29.7% (p=0.004).

“In the lowest GDP per capita countries, patients had higher disease activity levels, measured by DAPSA and MDA, but also by components of disease activity, in particular swollen joint countand body surface area of psoriasis, as well as higher patient-reported disease impact,” investigators concluded. “There is a need for more equity in healthcare.”


Lucasson F, Kiltz U, Kalyoncu U, et al. Disparities in healthcare in psoriatic arthritis: an analysis of 439 patients from 13 countries [published correction appears in RMD Open. 2022 May;8(1):]. RMD Open. 2022;8(1):e002031. doi:10.1136/rmdopen-2021-002031